ACA & The New Normal

Employee Out-of-Pocket Health Plan Costs Skyrocketing

A Continuing Trend of Shifting Costs to Employees, Especially Families

INDIANAPOLIS, IN—(November 5, 2015)— Employees saw modest health plan rate increases in 2015, but out-of-pocket costs continue to skyrocket, according to the 2015 UBA Health Plan Survey, the nation’s most comprehensive benchmarking survey of employer-sponsored health plans.

UBA’s survey, with responses from more than 10,000 employers that mirror 99 percent of American businesses, finds that the average annual health plan cost per employee for all plans in 2015 is $9,736. This is a 2.4 percent increase from the previous year. Employees picked up $3,333 of that cost, while employers covered the balance of $6,403.

“This increase was modest because of employees enrolling in plans that aren’t as rich, combined with large group negotiating power and small group grandmothering,” said Les McPhearson, CEO of UBA. “Out-of-pocket costs, however, continue to surge. Premiums continue to rise, forcing many employers to manage this expanding price tag by shifting costs to their employees in the form of higher deductibles, out-of-pocket maximums, and copays for both singles and families.”

The survey finds median in-network deductibles for singles jumped 33 percent from $1,500 in 2014 to $2,000 in 2015, while deductibles for families remained unchanged at $4,000.

When out-of-network, families are hit hardest: their median deductible increased 16.7 percent from $6,000 in 2014 to $7,000 in 2015, while the costs for singles remained unchanged at $3,000.

Both singles and families are seeing large increases in median in-network out-of-pocket maximums (up 14.3 percent and 8.8 percent, respectively, to $4,000 and $8,700). However, again for out-of-network costs, families are bearing larger dollar increases ($2,000) versus singles ($1,000).

Five-Year Trends

As previously noted, the 2015 increases in out-of-pocket costs and deductibles for both singles and families are indicative of the skyrocketing cost trends that the market has seen over the past five years. Median in-network single deductibles have doubled, and employees’ median out-of-network deductibles increased 50 percent. The median in-network deductible for families increased 33 percent and the out-of-network deductible increase was a staggering 75 percent in just five years, according the survey.

Single employee out-of-pocket maximums for in-network increased 33 percent and out-of-network increased 50 percent, while in-network maximums for families rose 45 percent and out-of-network rose 50 percent.

“Out-of-network expenses are not subject to ACA limitations, which means they’ll likely continue to increase significantly as employers continue to shift a greater share of expenses to employees through out-of-pocket cost increases and reductions in family benefits,” said McPhearson. “If we only look at slices of the health insurance market, it might appear that costs have remained relatively steady. A closer look at how much of the cost has been shifted to employees, however, reveals a much different story.”

Premiums continue to rise, forcing many employers to manage this expanding price tag by shifting costs to their employees in the form of higher deductibles, out-of-pocket maximums, and copays for both singles and families

For further information about the latest in employer-sponsored health plan trends, order a copy of the 2015 UBA Health Plan Survey Executive Summary at




About the UBA Health Plan Survey
Data released in the 2015 UBA Health Plan Survey contains the validated responses of 18,186 health plans, sponsored by 10,804 employers, who cumulatively employ more than two million employees and more than five million total lives. Individually validated responses from employers in more than 3,000 communities were utilized in compiling the database.
While other surveys primarily target large employers, the focus of the UBA survey is to report results that are applicable to the small and mid-size companies that represent the overwhelming majority of the nation’s employers, while also including a mix of large companies in rough proportion to their actual prevalence nationally.
The survey includes plan renewals from June 2014 to May 2015 through the joint effort of 129 of the nation’s premier independent employee benefit advisory firms and their clients. The national distribution of UBA Partner Firms, the diversity of their client base, and the extraordinary number of survey responses provided a unique basis to conduct a non-probability sample survey that yields benchmark results that pertain to a representative cross-section of the nation’s employers.
Contact a UBA Partner Firm for a customized benchmark survey based on industry, region and business size.
About United Benefit Advisors
United Benefit Advisors is the nation’s leading independent employee benefits advisory organization with more than 200 offices throughout the United States, Canada and the United Kingdom. As trusted and knowledgeable advisors, UBA Partners collaborate with more than 2,200 fellow professionals to deliver expertise, thought leadership and best-in-class solutions that positively impact employers and make a real difference in the lives of their employees and families. Employers, advisors and industry-related organizations interested in obtaining powerful results from the shared wisdom of our Partners should visit UBA online at